Idolina Maltos, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA10003511 Issued in WA

Practice address

3911 Castlevale Rd
Yakima, WA 98902-7807

Phone

(509) 453-8231

Fax

(509) 453-0130

NPI assigned

Aug 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Yakima Valley Dermatology Inc. , PS

  • Dermatology Physician
  • Yakima, WA
  • NPI 1710173703
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1891708574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3911 CASTLEVALE RD",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989027807",
            "telephone_number": "509-453-8231",
            "fax_number": "509-453-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3911 CASTLEVALE RD",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989027807",
            "telephone_number": "509-453-8231",
            "fax_number": "509-453-0130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALTOS",
        "first_name": "IDOLINA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "PA10003511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8329393",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Srilatha Malka
• Christopher Dennis Mallonee, L.I.C.S.W.
• Madeline Malmstrom
• Colin Joseph Malone, DDS
• Kelsy Anne Maloney, RN
• Srini Mandava, PHARMACIST
• Rachana Mandru, MD
• Damaris Manjarrez, LMP
• Luz Manjarrez
• Siva Krishna Mannem, MD

• Family Medicine Physician in Yakima, WA
• Providers in Yakima, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.